Provider Demographics
NPI:1477823110
Name:PAPPAS, PANAGIOTA (LMP)
Entity Type:Individual
Prefix:MRS
First Name:PANAGIOTA
Middle Name:
Last Name:PAPPAS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4122 FACTORIA BLVD SE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-4200
Mailing Address - Country:US
Mailing Address - Phone:425-590-9158
Mailing Address - Fax:
Practice Address - Street 1:4122 FACTORIA BLVD SE
Practice Address - Street 2:SUITE 202
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-4200
Practice Address - Country:US
Practice Address - Phone:425-590-9158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-11
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60169530225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA 60169530OtherNCTMB